NPIMap

Individual provider Active NPI

Randall A Black, D.O.

  • Anesthesiology Physician
  • Nampa, ID
National Provider Identifier
1922028083
Registry record updated Jan 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
O-0445 Issued in ID
Practice address
1512 12TH Ave Rd
Anesthesiology Consultants of Idaho
Nampa, ID 83686-6008
Phone
(208) 571-9043
NPI assigned
Jul 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X O-0445 ID Primary

Addresses

Primary practice location

1512 12TH Ave Rd
Anesthesiology Consultants of Idaho
Nampa, ID 83686-6008

Mailing address

1512 12TH Ave Rd
Nampa, ID 83686-6008
Phone (208) 463-5029

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070821000231 ID Practitioner - Anesthesiology 6103918297 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesiology Consultants of Treasure Valley PLLC 27 clinicians

Practice addresses (Care Compare)

8800 W Emerald St
Boise, ID 83704-8205
Phone (208) 373-5000

Hospital & facility affiliations

  • Treasure Valley Hospital Hospital, Boise, ID, CCN 130063
  • Saint Alphonsus Regional Medical Center Hospital, Boise, ID, CCN 130007

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesiology Consultants of Treasure Valley PLLC Anesthesiology CurrentSince Mar 19, 2018 Accepting new patients

Locations

8800 W Emerald St
Boise, ID 83704
Phone (208) 373-5000

1512 12th Ave Rd
Nampa, ID 83686
Phone (208) 463-5000

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1200528000000",
    "number": "1922028083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1512 12TH AVE RD",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836866008",
            "telephone_number": "208-463-5029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1512 12TH AVE RD",
            "address_2": "ANESTHESIOLOGY CONSULTANTS OF IDAHO",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836866008",
            "telephone_number": "208-571-9043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "RANDALL",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2008-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "ID",
            "license": "O-0445",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nampa, ID

Sources for this page

Verify at the official NPI Registry.